SAS - D.S.A.P. Jaén

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Vol. 28, nº 32. Evaluación del plan de inspección basado en el riesgo de actividades de tatuajes, micropigmentación y piercing, PIBR-TMP: resultados de la programación 2022 y plan de acción
(Consejeria de Salud y Consumo, 2023-08-11) Servicio de Vigilancia y Salud Laboral
Enfermedades de Declaración Obligatoria por provincias. Semana 31/2023 y acumulado desde la semana 01/2023. Datos provisionales. Incluye además el artículo titulado “Evalaución del plan de inspección basado en el riesgo de actividades de tatuajes, micropigmentación y piercing, PIBR-TMP: resultados de la programación 2022 y plan de acción”, de “Juan Antonio Ortiz Batanero, José Enrique Fernández Alcauza, Francisco José Marchena Fernández”.
[Influence of the companion in Primary Care consultations on communication skills and interview time].
(2022-06-29) Pérez-Milena, Alejandro; Zafra-Ramírez, Natalia; Ramos-Ruiz, Juan Andrés; Rodríguez-Bayón, Antonina; Zafra-Ramírez, Javier
To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. Cross-sectional descriptive study. 10 Primary Care Centers. Resident doctors of Family and Community Medicine. Peer review of video recordings of clinical demand consultations. CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.
[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)].
(2021-07-16) Pérez-Milena, Alejandro; Leyva-Alarcón, Ana; Barquero-Padilla, Raquel M; Peña-Arredondo, Melody; Navarrete-Espinosa, Cristóbal; Rosa-Garrido, Carmen
To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. Observational, retrospective (audit of medical records). Urban Primary Care Center of Andalusia (Spain). Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.
Breastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study.
(2022-02-22) Rodríguez-Gallego, Isabel; Strivens-Vilchez, Helen; Agea-Cano, Irene; Marín-Sánchez, Carmen; Sevillano-Giraldo, María Dolores; Gamundi-Fernández, Concepción; Berná-Guisado, Concepción; Leon-Larios, Fatima
The pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and economic circumstances. The objective of this study is to explore the impact of the pandemic and of the measures adopted on breastfeeding initiation and maintenance. A qualitative descriptive study was conducted by means in-depth semi-structured interviews, until reaching data saturation. The study was conducted between the months of January to May 2021. Participants were recruited by midwives from the Primary Care Centres of the Andalusian provinces provinces of Seville, Cádiz, Huelva, Granada, and Jaén. The interviews were conducted via phone call and were subsequently transcribed and analysed by means of reflexive inductive thematic analysis, using Braun and Clarke's thematic analysis. A total of 30 interviews were conducted. Five main themes and ten subthemes were developed, namely: Information received (access to the information, figure who provided the information), unequal support from the professionals during the pandemic (support to postpartum hospitalization, support received from Primary Health Care during the postpartum period), social and family support about breastfeeding (support groups, family support), impact of confinement and of social restriction measures (positive influence on breastfeeding, influence on bonding with the newborn), emotional effect of the pandemic (insecurity and fear related to contagion by coronavirus, feelings of loneliness). The use of online breastfeeding support groups through applications such as WhatsApp®, Facebook® or Instagram® has provided important breastfeeding information and support sources. The main figure identified that has provided formal breastfeeding support during this period was that of the midwife. In addition, the social restrictions inherent to the pandemic have exerted a positive effect for women in bonding and breastfeeding, as a consequence of the increase in the time spent at their homes and in the family nucleus co-living.
Body mass index interacts with a genetic-risk score for depression increasing the risk of the disease in high-susceptibility individuals.
(Nature Publishing Group, 2022-01-04) Anguita-Ruiz, Augusto; Zarza-Rebollo, Juan Antonio; Perez-Gutierrez, Ana M; Molina, Esther; Gutierrez, Blanca; Bellon, Juan Angel; Moreno-Peral, Patricia; Conejo-Ceron, Sonia; Aiarzagüena, Jose Maria; Ballesta-Rodriguez, M Isabel; Fernandez, Anna; Fernandez-Alonso, Carmen; Martin-Perez, Carlos; Monton-Franco, Carmen; Rodriguez-Bayon, Antonina; Torres-Martos, Alvaro; Lopez-Isac, Elena; Cervilla, Jorge; Rivera, Margarita; Spanish Ministry of Health, the Institute of Health Carlos III (ISCIII), and the European Regional Development Fund; Andalusian Council of Health; Spanish Network of Primary Care Research, redIAPP; Mental Health, Services and Primary Care Málaga group
Depression is strongly associated with obesity among other chronic physical diseases. The latest mega- and meta-analysis of genome-wide association studies have identified multiple risk loci robustly associated with depression. In this study, we aimed to investigate whether a genetic-risk score (GRS) combining multiple depression risk single nucleotide polymorphisms (SNPs) might have utility in the prediction of this disorder in individuals with obesity. A total of 30 depression-associated SNPs were included in a GRS to predict the risk of depression in a large case-control sample from the Spanish PredictD-CCRT study, a national multicentre, randomized controlled trial, which included 104 cases of depression and 1546 controls. An unweighted GRS was calculated as a summation of the number of risk alleles for depression and incorporated into several logistic regression models with depression status as the main outcome. Constructed models were trained and evaluated in the whole recruited sample. Non-genetic-risk factors were combined with the GRS in several ways across the five predictive models in order to improve predictive ability. An enrichment functional analysis was finally conducted with the aim of providing a general understanding of the biological pathways mapped by analyzed SNPs. We found that an unweighted GRS based on 30 risk loci was significantly associated with a higher risk of depression. Although the GRS itself explained a small amount of variance of depression, we found a significant improvement in the prediction of depression after including some non-genetic-risk factors into the models. The highest predictive ability for depression was achieved when the model included an interaction term between the GRS and the body mass index (BMI), apart from the inclusion of classical demographic information as marginal terms (AUC = 0.71, 95% CI = [0.65, 0.76]). Functional analyses on the 30 SNPs composing the GRS revealed an over-representation of the mapped genes in signaling pathways involved in processes such as extracellular remodeling, proinflammatory regulatory mechanisms, and circadian rhythm alterations. Although the GRS on its own explained a small amount of variance of depression, a significant novel feature of this study is that including non-genetic-risk factors such as BMI together with a GRS came close to the conventional threshold for clinical utility used in ROC analysis and improves the prediction of depression. In this study, the highest predictive ability was achieved by the model combining the GRS and the BMI under an interaction term. Particularly, BMI was identified as a trigger-like risk factor for depression acting in a concerted way with the GRS component. This is an interesting finding since it suggests the existence of a risk overlap between both diseases, and the need for individual depression genetics-risk evaluation in subjects with obesity. This research has therefore potential clinical implications and set the basis for future research directions in exploring the link between depression and obesity-associated disorders. While it is likely that future genome-wide studies with large samples will detect novel genetic variants associated with depression, it seems clear that a combination of genetics and non-genetic information (such is the case of obesity status and other depression comorbidities) will still be needed for the optimization prediction of depression in high-susceptibility individuals.
Spatial analysis and prediction of the flow of patients to public health centres in a middle-sized Spanish city
(Univ naples federico ii, 2016-01-01) Ramos, Isabel; Cubillas, Juan J.; Feito, Francisco R.; Urena, Tomas; [Ramos, Isabel] Univ Jaen, Dept Cartog Geodet Engn & Photogrammetry, Campus Lagunillas, Jaen, Spain; [Cubillas, Juan J.] Univ Jaen, Dept Comp Sci, TIC Andalusian Res Plan 144, Jaen, Spain; [Feito, Francisco R.] Univ Jaen, Dept Comp Sci, TIC Andalusian Res Plan 144, Jaen, Spain; [Feito, Francisco R.] Univ Jaen, Dept Comp Sci, Jaen, Spain; [Urena, Tomas] Andalusian Hlth Serv, Jaen, Spain; Andalusian Health Service, Department of Equality, Health and Social Policies of the Junta of Andalusia, Spain
Human and medical resources in the Spanish primary health care centres are usually planned and managed on the basis of the average number of patients in previous years. However, sudden increases in patient demand leading to delays and slip-ups can occur at any time without warning. This paper describes a predictive model capable of calculating patient demand in advance using geospatial data, whose values depend directly on weather variables and location of the health centre people are assigned to. The results obtained here show that outcomes differ from one centre to another depending on variations in the variables measured. For example, patients aged 25-34 and 55-65 years visited health centres less often than all other groups. It was also observed that the higher the economic level, the fewer visits to health centres. From the temporal point of view, Monday was the day of greatest demand, while Friday the least. On a monthly basis, February had the highest influx of patients. Also, air quality and humidity influenced the number of visits; more visits during poor air quality and high relative humidity. The addition of spatial variables minimised the average error the predictive model from 7.4 to 2.4% and the error without considering spatial variables varied from the high of 11.8% in to the low of 2.5%. The new model reduces the values in the predictive model, which are more homogeneous than previously.
Comparison of the Effectiveness of an Abbreviated Program versus a Standard Program in Mindfulness, Self-Compassion and Self-Perceived Empathy in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain.
(MDPI, 2021-04-14) Perula-de Torres, Luis Angel; Verdes-Montenegro-Atalaya, Juan Carlos; Melus-Palazon, Elena; Garcia-de Vinuesa, Leonor; Valverde, Francisco Javier; Rodriguez, Luis Alberto; Lietor-Villajos, Norberto; Bartolome-Moreno, Cruz; Moreno-Martos, Herminia; Garcia-Campayo, Javier; Gonzalez-Santos, Josefa; Rodriguez-Fernandez, Paula; Leon-Del-Barco, Benito; Soto-Camara, Raul; Gonzalez-Bernal, Jeronimo J; Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness; European Union ERDF funds; Andalusian Society of Family and Community Medicine; Primary Care of the Andalusian Health Service; The Minduudd Collaborative Study Group,
Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271; p = 0.042; η2 = 0.067) and self-compassion (F(2,91) = 6.046; p = 0.003; η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880; p = 0.025; η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.
Effect of the coronavirus disease 2019 pandemic on antibiotic use in primary care.
(Elsevier Ltd, 2021-02-02) Peñalva, German; Benavente, Regina Sandra; Perez-Moreno, Maria Antonia; Perez-Pacheco, Maria Dolores; Perez-Milena, Alejandro; Murcia, Jose; Cisneros, Jose Miguel
During the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ), disruption of antimicrobial stewardship interventions has become a matter of concern. Antimicrobial resistance and the many unintended negative clinical consequences resulting from antibiotic misuse and overuse will persist and may potentially be aggravated by the pandemic , making it necessary to measure its impact on antibiotic use in all health -care settings
Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial.
(Royal College of General Practitioners, 2021-01-28) Moreno-Peral, Patricia; Conejo-Ceron, Sonia; de-Dios-Luna, Juan; King, Michael; Nazareth, Irwin; Martin-Perez, Carlos; Fernandez-Alonso, Carmen; Ballesta-Rodriuez, Maria Isabel; Fernandez, Anna; Aiarzaguena, Jose Maria; Monton-Franco, Carmen; Bellon, Juan Angel
In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26-27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = -2.7% [95% CI = -5.1% to -0.3%]; P = 0.029). A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.
Efficacy of Bifidobacterium breve CECT7263 for infantile colic treatment: an open-label, parallel, randomised, controlled trial.
(Brill - Wageningen Academic Publishers, 2020-09-16) Maldonado-Lobon, J A; Blanco-Rojo, R; Maldonado, J; Ali, M A; Almazan, M V; Suanes-Cabello, A; Callejon, E; Jaldo, R; Benavides, M R; Negrillo, A M; Sañudo, A; Rodriguez, C; Bañuelos, O; Fonolla, J; Olivares, M; PROBI-COLIC group
Infantile colic is a prevalent condition characterised by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of Bifidobacterium breve CECT7263 and a combination of this and Lactobacillus fermentum CECT5716 versus simethicone in reducing the daily time spent crying in colicky infants. A multicentre randomised, open-label, parallel, controlled trial of 28 days was performed in 150 infants who were diagnosed with colic according to the Rome III criteria and who randomly received simethicone (80 mg/day; Simethicone group), B. breve CECT7263 (2×108 cfu/day, Bb group), or a combination of L. fermentum CECT5716 and B. breve CECT7263 (1×108 cfu/day per strain, Bb+Lf group). The main outcomes were minutes of crying per day and the percentage of reduction in daily crying from baseline. Data were analysed per intention to treat. All treatments significantly decreased the daily crying time at the end of the intervention (P-time
Relationship between olive oil consumption and ankle-brachial pressure index in a population at high cardiovascular risk.
(Elsevier, 2020-10-07) Sanchez-Quesada, Cristina; Toledo, Estefania; Gonzalez-Mata, Guadalupe; Ramos-Ballesta, Maria Isabel; Peis, Jose Ignacio; Martinez-Gonzalez, Miguel Angel; Salas-Salvado, Jordi; Corella, Dolores; Fito, Montserrat; Romaguera, Dora; Vioque, Jesus; Alonso-Gomez, Angel M; Wärnberg, Julia; Martinez, J Alfredo; Serra-Majem, Luis; Estruch, Ramon; Tinahones, Francisco J; Lapetra, Jose; Pinto, Xavier; Tur, Josep A; Garcia-Rios, Antonio; Cano-Ibañez, Naomi; Matia-Martin, Pilar; Daimiel, Lidia; Sanchez-Rodriguez, Ruben; Vidal, Josep; Vazquez, Clotilde; Ros, Emilio; Hernandez-Alonso, Pablo; Barragan, Rocio; Muñoz-Martinez, Julia; Lopez, Meritxell; Gonzalez-Palacios, Sandra; Vaquero-Luna, Jessica; Crespo-Oliva, Edelys; Zulet, M Angeles; Diaz-Gonzalez, Vanessa; Casas, Rosa; Fernandez-Garcia, Jose Carlos; Santos-Lozano, Jose Manuel; Galera, Ana; Ripoll-Vera, Tomas; Buil-Cosiales, Pilar; Canudas, Silvia; Martinez-Lacruz, Raul; Perez-Vega, Karla-Alejandra; Rios, Angel; Lloret-Macian, Rosario; Moreno-Rodriguez, Anai; Ruiz-Canela, Miguel; Babio, Nancy; Zomeño Fajardo, Maria Dolores; Gaforio, Jose J; Spanish government, ISCIII, through the Fondo de Investigacion para la Salud (FIS); European Regional Development Fund; European Research Council; Consejería de Salud de la Junta de Andalucía; CIBEROBN
The aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome. We performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure. Among 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48]). In a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed.
Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.
(Elsevier, 2019-07-16) Rodriguez-Baño, J; Perez-Moreno, M A; Peñalva, G; Garnacho-Montero, J; Pinto, C; Salcedo, I; Fernandez-Urrusuno, R; Neth, O; Gil-Navarro, M V; Perez-Milena, A; Sierra, R; Estella, A; Lupion, C; Irastorza, A; Marquez, J L; Pascual, A; Rojo-Martin, M D; Perez-Lozano, M J; Valencia-Martin, R; Cisneros, J M; PIRASOA Programme Group
Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.
[Accomplishment of preventive activities proposed by resident doctors of Family Medicine in Primary Care and its relationship with communication skills].
(2019-06-04) Zafra-Ramírez, Natalia; Pérez-Milena, Alejandro; Valverde-Bolívar, Francisco Javier; Rodríguez-Bayón, Antonina; Delgado-Rodríguez, Miguel
To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities. A descriptive multicentre study assessing medical consultations video recording. Eight Primary Healthcare centres in Jaen (Andalucia). Seventy-three resident physicians (4th year) filmed and observed with patients. Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed. Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10). Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer.
Family physicians' views on participating in prevention of major depression. The predictD-EVAL qualitative study.
(Public Library of Science, 2019-05-30) Moreno-Peral, Patricia; Conejo-Ceron, Sonia; Fernandez, Anna; Martun-Perez, Carlos; Fernandez-Alonso, Carmen; Rodriguez-Bayon, Antonina; Ballesta-Rodriguez, Maria Isabel; Aiarzagüena, Jose Maria; Monton-Franco, Carmen; King, Michael; Nazareth, Irwin; Bellon, Juan Angel
The predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions. To seek the opinions of these FPs on the potential successful components of the predictD intervention for the primary prevention of depression in primary care and to identify areas for improvement. Qualitative study with FPs who delivered the predictD intervention at 35 urban primary care centres in seven Spanish cities. Face-to-face semi-structured interviews adopting a phenomenological approach. The data was triangulated by three investigators using thematic analysis and respondent validation was carried out. Sixty-seven FPs were interviewed and they indicated strategies used to perform the predictD intervention, including specific communication skills such as empathy and the activation of patient resources. They perceived barriers such as lack of time and facilitators such as prior acquaintance with patients. FPs recognized the positive consequences of the intervention for FPs, patients and the doctor-patient relationship. They also identified strategies for future versions and implementations of the predictD intervention. The FPs who carried out the predictD intervention identified factors potentially associated with successful prevention using this program and others that could be improved. Their opinions about the predictD intervention will enable development of a more effective and acceptable version and its implementation in different primary health care settings.
A 48-Year-Old Woman Presenting With Syncope and Shortness of Breath.
(Elsevier, 2018) Alonso, Joaquin Valle; Fonseca Del Pozo, Francisco Javier; Vaquero, Manuel; Farhad Islam, Izzy
A 48-year-old woman with no previous medical history, who is normally fit and healthy, and with no recent travel abroad was admitted in the ED after a syncopal episode at home. In the anamnesis described, a collapse episode occurred from standing position at home while preparing to go to work. There were no clear provoking factors, no prodromes, and no associated stereotyped movements. It lasted approximately 1 minute until complete recovery. She had been complaining of dyspnea on exertion for the last 3 days, had no chest pain, and had no limb swelling or other remarkable abnormalities. On ambulance arrival, the room air oxygen saturation was 89% to 90%, heart rate was 110 beats/min, and BP was 121/72 mm Hg without orthostatic changes.
A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.
(2018-02-23) Fernández, Anna; Mendive, Juan M; Conejo-Cerón, Sonia; Moreno-Peral, Patricia; King, Michael; Nazareth, Irwin; Martín-Pérez, Carlos; Fernández-Alonso, Carmen; Rodríguez-Bayón, Antonina; Aiarzaguena, Jose Maria; Montón-Franco, Carmen; Serrano-Blanco, Antoni; Ibañez-Casas, Inmaculada; Rodríguez-Sánchez, Emiliano; Salvador-Carulla, Luis; Garay, Paola Bully; Ballesta-Rodríguez, María Isabel; LaFuente, Pilar; Del Mar Muñoz-García, María; Mínguez-Gonzalo, Pilar; Araujo, Luz; Palao, Diego; Gómez, María Cruz; Zubiaga, Fernando; Navas-Campaña, Desirée; Aranda-Regules, Jose Manuel; Rodriguez-Morejón, Alberto; de Dios Luna, Juan; Bellón, Juan Ángel
Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.
Sepsis, fluid resuscitation and bedside echocardiography.
(Oxford University Press, 2017-10-23) Alonso, J V; Del Pozo, F J F; Vaquero, M; Islam, I
The surviving sepsis campaign recommends that every patient must receive 30 cc/kg fluid for the resuscitation from sepsisinduced hypoperfusion within the first 3 h.1 In an acute clinical scenario, it is very difficult to know the right amount of fluid to give to a patient with sepsis. Sepsis sometimes coexists with hypervolaemia in patients with congestive heart failure or pul monary hypertension; furthermore many conditions mimic sepsis by meeting criteria for systemic inflammatory response syndrome including anaphylaxis, aspiration, bowel obstruction, colitis, hypovolemia, pancreatitis, pulmonary embolism, GI bleeding, heart failure, acute coronary syndrome, spinal cord injury, toxic overdose, medication effect and vasculitis. If these conditions are not considered, there is potential for increased mortality and morbidity.
Communication with patients and the duration of family medicine consultations.
(2017-10-18) Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Moreno Martos, Herminia; Cózar García, Inmaculada; Torío Durántez, Jesús
To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Cross-sectional multicentre study. Primary Healthcare Centres in Andalusia, Spain. A total of 119 tutors and family medicine physician residents. Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2=0.32). There was no correlation between physician or patient gender, or problem type. A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation.
Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression.
(2017) Moreno-Peral, Patricia; Conejo-Cerón, Sonia; Rubio-Valera, Maria; Fernández, Anna; Navas-Campaña, Desirée; Rodríguez-Morejón, Alberto; Motrico, Emma; Rigabert, Alina; Luna, Juan de Dios; Martín-Pérez, Carlos; Rodríguez-Bayón, Antonina; Ballesta-Rodríguez, María Isabel; Luciano, Juan Vicente; Bellón, Juan Ángel
To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
[Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design].
(2017-05-10) Pérez-Milena, Alejandro; Redondo-Olmedilla, Manuel de Dios; Martínez-Fernández, María Luz; Jiménez-Pulido, Idoia; Mesa-Gallardo, Inmaculada; Leal-Helmling, Francisco Javier
To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. Descriptive design: A total of 1,558 questionnaires, age 14.2±0.3years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P6 standard drink units weekly; P A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk.

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